Medicaid’s Role for Medicare Beneficiaries

March 23, 2017

According to a new W.K. Kellogg Foundation issue brief released on February 16th, 2017, Medicaid fills important gaps in coverage left by Medicare, particularly for seniors, including long-term care in both nursing homes and community settings. Medicaid also helps low-income seniors afford some or all of their Medicare premiums. This issue brief helps to inform the national debate around potential changes and reductions in Medicaid financing.

Seniors who receive both Medicare and Medicaid often have more intensive healthcare needs, according to the Foundation. In health care policy circles, these individuals are known as “Dual Eligible”. With regard to those who are dual eligible, the issue brief points out that:

Nearly three in four Medicare beneficiaries who receive Medicaid have three or more chronic conditions, such as diabetes or heart disease, which can require regular doctor appointments, medication, and/or medical tests.

More than 60% of Medicare beneficiaries who receive Medicaid need help with daily self-care activities, such as eating, bathing, or dressing, which are important for independent living.

Nearly six in 10 Medicare beneficiaries who receive Medicaid have a cognitive or mental impairment, such as dementia, which can create the need for supports to live safely at home.

More intensive healthcare needs mean Medicare beneficiaries spend more on Medicaid. For example, although Medicare beneficiaries make up 15% of Medicaid enrollment nationally, they account for 36% of national Medicaid spending. In nearly three-quarters of states, more than 30% of the total Medicaid spending is devoted to Medicare beneficiaries, and in six states, spending for Medicare beneficiaries comprises more than 45% or Medicaid budgets. The needs and cost of care of the dually enrolled Medicaid and Medicare populations leave them particularly vulnerable to potential changes and reductions in federal Medicaid spending.

The brief goes on to say that President Donald Trump and other Congressional leaders have called for changes in Medicaid financing that could limit federal funding through a block grant or per capita cap, which may affect Medicare beneficiaries who receive Medicaid. Changes to Medicaid’s financing structure could have significant consequences for enrollees and states and the possible changes necessitate careful consideration regarding their impact on Medicare beneficiaries.

The coming weeks and months will allow the public to understand how the story related to those who are Dual Eligible will unfold.

Advocacy & Communication Solutions, LLC (ACS) has worked on Medicaid policy since the firm’s inception in 2004 and has helped non-profits and government navigate health-related policy at the state and federal levels. ACS client HMS, is the nation’s leader in cost containment, program integrity, and coordination of benefits solutions for government-funded and commercial healthcare entities. HMS works with state Medicaid agencies to help detect fraud as part of its contract to provide program integrity services, which allows for government to save millions within their Medicaid programs.